EJAEur J Anaesthesiol 2023:40:226-304GUIDELINESManagement of severe peri-operative bleeding:Guidelinesfrom the European Society of Anaesthesiology andIntensive CareSecond update 2022Sibylle Kietaibl,Aamer Ahmed,Arash Afshari,Pierre Albaladejo,Cesar Aldecoa,Giedrius Barauskas,Edoardo De Robertis,David Faraoni,Daniela C.Filipescu,Dietmar Fries,Anne Godier,Thorsten Haas,Matthias Jacob,Marcus D.Lance,Juan V.Llau,Jens Meier,Zsolt Molnar,Lidia Mora,Niels Rahe-Meyer,Charles M.Samama,Ecaterina Scarlatescu,Christoph Schlimp,Anne J.Wikkelso and Kai ZacharowskiBACKGROUND Management of peri-operative bleeding is253 sentences of guidance,strong consensus (>90%complex and involves multiple assessment tools and strate-agreement)was achieved in 97%and consensus (75 togies to ensure optimal patient care with the goal of reducing90%agreement)in 3%.morbidity and mortality.These updated guidelines from theEuropean Society of Anaesthesiology and Intensive CareDISCUSSION Peri-operative bleeding management encom-passes the patient's journey from the pre-operative state(ESAIC)aim to provide an evidence-based set of recom-through the postoperative period.Along this journey,manymendations for healthcare professionals to help ensurefeatures of the patient's pre-operative coagulation status,improved clinical management.underlying comorbidities,general health and the proceduresDESIGN A systematic literature search from 2015 to 2021that they are undergoing need to be taken into account.Dueof several electronic databases was performed withoutto the many important aspects in peri-operative nontraumalanguage restrictions.Grading of Recommendations,bleeding management,guidance as to how best approachAssessment,Development and Evaluation (GRADE)wasand treat each individual patient are key.Understandingused to assess the methodological quality of the includedwhich therapeutic approaches are most valuable at eachstudies and to formulate recommendations.A Delphitimepoint can only enhance patient care,ensuring the bestmethodology was used to prepare a clinical practiceoutcomes by reducing blood loss and,therefore,overallguideline.morbidity and mortality.RESULTS These searches identified 137999 articles.AllCONCLUSION All healthcare professionals involved in thearticles were assessed,and the existing 2017 guidelinesmanagement of patients at risk for surgical bleeding shouldwere revised to incorporate new evidence.Sixteen recom-be aware of the current therapeutic options and approachesmendations derived from the systematic literature search,that are available to them.These guidelines aim to provideand four clinical guidances retained from previous ESAICspecific guidance for bleeding management in a variety ofguidelines were formulated.Using the Delphi process onclinical situations.From the Department of Anaesthesiology&Intensive Care,Evangelical Hospital Vienna and Sigmund Freud Private University Vienna,Austria(SK),Department ofAnaesthesia and Critical Care,University Hospitals of Leice
